Bladder cancer by section Watson G7

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Submitted by the GROUP 7, BSN 3 WATSON

CANCER

Cancer is the growth of abnormal cells

in the body. These extra cells grow

together and form masses, called

tumors. In bladder cancer, these

growths happen in the bladder.

L A D D E R A N C E R B COVERVIEW

INTRODUCTION

ETIOLOGY

PATHOPHYSIOLOGY

ASSESSMENT

COMPLICATIONS

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THE BLADDER

• The bladder is the part of your urinary

tract that stores your urine until you are

ready to let it out.

• Bladder cancer can usually be cured if

it is found and treated early. And most

bladder cancer is found early.

L A D D E R A N C E R B C

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INTRODUCTION

ETIOLOGY

PATHOPHYSIOLOGY

ASSESSMENT

COMPLICATIONS

OVERVIEW

INTRODUCTION

OVERVIEW

Bladder cancer is the rapid, uncontrolled

growth of abnormal cells in the bladder.

Cancer usually begins in the lining of the

bladder (superficial bladder cancer). The

cancerous cells may grow through the

lining into the muscular wall of the

bladder.

L A D D E R A N C E R B C

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ETIOLOGY

PATHOPHYSIOLOGY

ASSESSMENT

COMPLICATIONS

INTRODUCTION

OVERVIEW

Invasive bladder cancer may spread to

lymph nodes, other organs in the pelvis

(causing problems with kidney and

bowel function), or other organs in the

body, such as the liver and lungs.

L A D D E R A N C E R B C

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ETIOLOGY

PATHOPHYSIOLOGY

ASSESSMENT

COMPLICATIONS

L A D D E R A N C E R B CINTRODUCTION

OVERVIEW

Bladder cancer is classified by stage and

grade. The stage is determined by the

cancer growth in the bladder wall and

how far it has spread to nearby tissues

and other organs, such as the lungs, the

liver, or the bones.

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ETIOLOGY

PATHOPHYSIOLOGY

ASSESSMENT

COMPLICATIONS

INTRODUCTION

OVERVIEW

The grade of bladder cancer is

determined by how the cancer cells look

in comparison with normal bladder cells.

L A D D E R A N C E R B C

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ETIOLOGY

PATHOPHYSIOLOGY

ASSESSMENT

COMPLICATIONS

L A D D E R A N C E R B CETIOLOGY

OVERVIEW

INTRODUCTION• Cigarette smoking

• Chemical exposures at work

• Bladder Stones

• High Cholesterol Intake

• High Urinary Ph

• Pelvic Radiation Therapy

• Cancer Arising from the prostate,

colon and rectum in males

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PATHOPHYSIOLOGY

ASSESSMENT

COMPLICATIONS

L A D D E R A N C E R B CETIOLOGY

OVERVIEW

INTRODUCTION NON MODIFIABLE RISK FACTORS:

• Age: Seniors are at the highest risk of

developing bladder cancer.

• Sex: Men are three times more likely

than women to have bladder cancer.

• Race: Whites have a much higher risk

of developing bladder cancer than other

races.

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PATHOPHYSIOLOGY

ASSESSMENT

COMPLICATIONS

L A D D E R A N C E R B CETIOLOGY

OVERVIEW

INTRODUCTION

• History of bladder cancer: If you have

had bladder cancer in the past, your risk

of developing another bladder cancer is

higher than if you had never had

bladder cancer.

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PATHOPHYSIOLOGY

ASSESSMENT

COMPLICATIONS

ETIOLOGY

OVERVIEW

INTRODUCTION

• Chronic bladder inflammation:

Frequent bladder infections, bladder

stones, and other urinary tract problems

that irritate the bladder increase the risk

of developing a cancer, more commonly

squamous cell carcinoma.

L A D D E R A N C E R B C

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PATHOPHYSIOLOGY

ASSESSMENT

COMPLICATIONS

L A D D E R A N C E R B CETIOLOGY

OVERVIEW

INTRODUCTION • Birth defects: Some people are born

with a visible or invisible defect that

connects their bladder with another

organ in the abdomen or leaves the

bladder exposed to continual infection.

This increases the bladder's vulnerability

to cellular abnormalities that can lead to

cancer.

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PATHOPHYSIOLOGY

ASSESSMENT

COMPLICATIONS

L A D D E R A N C E R B C

PATHOPHYSIOLOGY

OVERVIEW

INTRODUCTION

ETIOLOGY

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ASSESSMENT

COMPLICATIONS

Exposure of bladder to Carcinogen

Premalignant proliferative changes in transitional cell layer (dysplasia)

Papillary or transitional cell tumors (trigoone of the bladder & lateral walls)

Staging of the tumor (depth of penetration) & degree of metastasis

Metastasis to nearby organs

Invasion to pelvic lymph nodes& other organs

Poor prognosis (death)

ASSESSMENT

OVERVIEW

INTRODUCTION

ETIOLOGY

PATHOPHYSIOLOGY

SYMPTOMS

L A D D E R A N C E R B C

PICTURES

• Hematuria

• Dysuria

• Oliguria

• Frequent urinary tract infections

(UTIs).

• Flank Pain

• Weight loss

• Anemia

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DIAGNOSIS

L A D D E R A N C E R B C

ASSESSMENT

OVERVIEW

INTRODUCTION

ETIOLOGY

PATHOPHYSIOLOGY

DIAGNOSIS

SYMPTOMS

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PICTURES

• BTA – Bladder Tumor Antigen Test• NMPZZ – Nuclear Matrix Protein Test• TRAP – Telomeric Repeat Amplification Protocol Assay• IVP – Intravenous Pyelograph• XRAY• MRI – Magnetic Resonance Imaging• CT Scan – Computerized Tomography Scan• UTZ – Ultrasonography• CEA – Cerum Carcinoembryonic Antigen• Biopsy

L A D D E R A N C E R B C

ASSESSMENT

OVERVIEW

INTRODUCTION

ETIOLOGY

PATHOPHYSIOLOGY

PICTURES

Bladder cancer : the bladder wall is massively

infiltered by an ulcerated and hemorragic tumor.

Courtesy Pierre Bedossa

SYMPTOMS

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DIAGNOSIS

L A D D E R A N C E R B C

ASSESSMENT

OVERVIEW

INTRODUCTION

ETIOLOGY

PATHOPHYSIOLOGY

Cystoscopic view of a papillary bladder tumor

(top); the bladder wall is visible on the bottom

right.

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PICTURES

SYMPTOMS

DIAGNOSIS

L A D D E R A N C E R B C

ASSESSMENT

OVERVIEW

INTRODUCTION

ETIOLOGY

PATHOPHYSIOLOGY

This photograph illustrates mucinous

adenocarcinoma of the urinary bladder. The tumor

has a glistening surface.

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PICTURES

SYMPTOMS

DIAGNOSIS

ASSESSMENT

OVERVIEW

INTRODUCTION

ETIOLOGY

PATHOPHYSIOLOGY

PICTURES

L A D D E R A N C E R B C

SYMPTOMSCOMPLICATIONS

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DIAGNOSIS

L A D D E R A N C E R B C

COMPLICATIONS

OVERVIEW

INTRODUCTION

ETIOLOGY

ASSESSMENT

• Metastasis to nearby organs

• Hydronephrosis

• Ascitis

• Infertility

PATHOPHYSIOLOGY

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L A D D E R A N C E R B CINTERVENTIONS 1. Chronic pain related to progression of disease

process

•Direct tumor involvement is the primary cause of

cancer pain. It is believed to be the mechanical,

resulting from stretching of the tissues and

compression. Chemicals from and toxins that

activate and sensitize the nociceptors &

mechanoceptors that is also responsible for cancer

pain.

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NURSING DIAGNOSIS

L A D D E R A N C E R B CINTERVENTIONS

2. Imbalanced nutrition: less than body

requirements related to disease

process.

• The anorexia-cachexia syndrome is the

most common cause of malnutrition in

cancer cancers parasitic activity reduces

the nutrients available to the body.

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NURSING DIAGNOSIS

L A D D E R A N C E R B CINTERVENTIONS

3. Impaired urinary elimination related

to bladder mass as evidenced by dysuria

and oliguria

Metastasis of the bladder affects the

normal process and patterns of voiding.

Infection of the urinary tract is the

common complication, producing

frequency, surgery dysuria and even

hematuria.

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NURSING DIAGNOSIS

L A D D E R A N C E R B CCHEMOTHERAPY with combination of

methotrexate, 5 fluorouracil,

vinblastine, doxorubicin (Adriamycin)

and cisplatin.

• IV CHEMOTHERAPY

• TOPICAL CHEMOTHERAPY

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NURSING DIAGNOSIS

INTERVENTIONS

MEDICAL

SURGICAL

NURSING

L A D D E R A N C E R B C• Transurethral resection or fulguration

of the bladder

• Urinary Diversion

• Cystectomy

• Simple

• Radical

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NURSING DIAGNOSIS

INTERVENTIONS

SURGICAL

MEDICAL

NURSING

L A D D E R A N C E R B C

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NURSING DIAGNOSIS

INTERVENTIONS

NURSING

MEDICAL

SURGICAL

• Encourage to stop smoking (if px is a

smoker)

• Pain Management

• Proper nutrition provision

• Emotional support

• Provide Education

•Encourage decision making

E P H R E C T O M Y NDEFINITION

TYPES

INDICATION

POST OP CARE

COMPLICATIONS

NURSING DIAGNOSIS

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A nephrectomy is the surgical removal of

a kidney, the organ that filters waste

from the blood and produces urine.

E P H R E C T O M Y NDEFINITION

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TYPES

INDICATION

POST OP CARE

COMPLICATIONS

NURSING DIAGNOSIS

• Partial nephrectomy – Part of one

kidney is removed.

• Simple nephrectomy – All of one

kidney is removed.

E P H R E C T O M Y NTYPES

DEFINITION

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INDICATION

POST OP CARE

COMPLICATIONS

NURSING DIAGNOSIS

• Radical nephrectomy – All of one

kidney is removed together with the

neighboring adrenal gland (the

adrenaline-producing gland that sits on

top of the kidney) and neighboring

lymph nodes.

• Bilateral nephrectomy – Both kidneys

are removed.

E P H R E C T O M Y NTYPES

DEFINITION

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INDICATION

POST OP CARE

COMPLICATIONS

NURSING DIAGNOSIS

E P H R E C T O M Y NINDICATION

DEFINITION

TYPES

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•kidney deformities (birth defects:

congenital abnormalities)

•injury (trauma)

•disease

•infection

•hypertension

•tumor

•removal of kidney from donor for kidney

transplant

POST OP CARE

COMPLICATIONS

NURSING DIAGNOSIS

E P H R E C T O M Y N

POST OP CARE

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INDICATION • Vital Signs Monitoring

• Monitor Urine output

• Assess for bleeding

• Maintain asepsis

• Pain Management (Anagesics)

COMPLICATIONS

NURSING DIAGNOSIS

DEFINITION

TYPES

E P H R E C T O M Y N

COMPLICATIONS

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POST OP CARE

•Blood clots in the legs that may travel to

the lungs

•Breathing problems

•Infection, including in the surgical wound,

lungs (pneumonia), bladder, or kidney

•Blood loss

• Reactions to medications

INDICATION

DEFINITION

TYPES

NURSING DIAGNOSIS

E P H R E C T O M Y N

NURSING DIAG.

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COMPLICATIONS

1. Ineffective breathing pattern related to flank incision• The surgical approaches to the kidney predisposes the patient to respiratory complications and paralytic ileus. If the pleural cavity has been entered during surgery, a pneumothorax may occur. These factor can lead to pain and limited chest movement during breathing and thus increases the risk of the patient for respiratory complication.

POST OP CARE

INDICATION

DEFINITION

TYPES

E P H R E C T O M Y N

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2. Acute pain related to surgical incision.

The patient may experience acute pain

which is sudden onset of the incision site.

Acute pain is transmitted by a delta fibers

that are myelated and transmit inpulses

rapidly and thus causes the [patient to

have an increased pulse rate, BP, and RR.

NURSING DIAG.

COMPLICATIONS

POST OP CARE

INDICATION

DEFINITION

TYPES

E P H R E C T O M Y N

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3. Urinary retention related to pain,

immobility and anesthesia• Urinary retention can occur post operatively in any patient , particularly if the surgery affected the perineal or anal regions and resulted in reflex spasm of the sphincters. General anesthesia reduces the bladder muscle innervations and suppresses the urge to void, impeding the bladder emptying.

NURSING DIAG.

COMPLICATIONS

POST OP CARE

INDICATION

DEFINITION

TYPES

R I N A R Y I V E R S I O NUDEFINITION

TYPES

INDICATION

POST OP CARE

COMPLICATIONS

NURSING DIAGNOSIS

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Refers to diverting the urinary

stream from the bladder so that it

exits by the way a a new avenue

D

TYPES

DEFINITION

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1. Ileal conduit2. Ureterostomy3. Continent cutaneous reservoir

4. Bladder substitute

R I N A R Y I V E R S I O NU DINDICATION

POST OP CARE

COMPLICATIONS

NURSING DIAGNOSIS

INDICATION

TYPES

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POST OP CARE

COMPLICATIONS

NURSING DIAGNOSIS

• Bladder cancer requiring cystectomy

• Neurogenic bladder conditions that

threaten renal function

• Severe radiation injury to the bladder

• Intractable incontinence in females

• Chronic pelvic pain syndromes

R I N A R Y I V E R S I O NU DDEFINITION

POST OP CARE

DEFINITION

TYPES

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INDICATION

COMPLICATIONS

NURSING DIAGNOSIS

• Vital Signs Monitoring

• Monitor Urine output

• Assess for bleeding

• Maintain asepsis

• Pain Management (Anagesics)

R I N A R Y I V E R S I O NU D

COMPLICATIONS

DEFINITION

TYPES

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INDICATION

POST OP CARE

NURSING DIAGNOSIS

• Incontinence

• Urinary reflux

• Anastomtic leaks

• Pyelonephritis

• Bacteriuria

• Calculi Erectile Dysfunction

• Electrolyte imbalances

R I N A R Y I V E R S I O NU D

NURSING DIAG.

DEFINITION

TYPES

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INDICATION

POST OP CARE

COMPLICATIONS

1. Acute pain related to surgical

incision.

2. Impaired skin integrity related to

surgical incision.

3.. Disturbed body image related to

Urinary diversion.

R I N A R Y I V E R S I O NU D

Y S T O S T O M Y CDEFINITION

INDICATION

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Is a surgical procedure wherein a

cystostomy tube is inserted through the

abdominal wall directly into the bladder.

POST OP CARE

COMPLICATIONS

NURSING DIAGNOSIS

INDICATION

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POST OP CARE

• Acute urinary retention

• Chronic Urinary Retention

• Urinary incontinence

• Enlarged prostate

• Urethral strictures

Y S T O S T O M Y C

COMPLICATIONS

NURSING DIAGNOSIS

DEFINITION

POST OP CARE

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COMPLICATIONS

• Vital Signs Monitoring

• Monitor Urine output

• Assess for bleeding

• Maintain asepsis

• Pain Management (Anagesics)

Y S T O S T O M Y C

NURSING DIAGNOSIS

DEFINITION

INDICATION

COMPLICATIONS

DEFINITION

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NURSING DIAGNOSIS

• Hematuria

• Bowel perforation during trocar

insertion

• Failure of the wound to close

• Urinary fistula

Y S T O S T O M Y CINDICATION

POST OP CARE

NURSING DIAG.

DEFINITION

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INDICATION

POST OP CARE

COMPLICATIONS

1. Acute pain related to surgical

incision.

2. Impaired skin integrity related to

surgical incision.

3.. Disturbed body image related to

Urinary diversion.

Y S T O S T O M Y C

Internet REFERENCES• http://en.wikipedia.org/wiki/Suprapubic_cystostomy

• http://emedicine.medscape.com/article/451882-overview• http://kidney.niddk.nih.gov/kudiseases/pubs/urostomy/index.htm• http://emedicine.medscape.com/article/451882-overview

• http://emedicine.medscape.com/article/451882-overview

Book REFERENCES• Lemone, Burke, Medical Surgical Nursing, 2004, Third Edition • Timby & Smith, Introductory Medical Surgical Nursing, 2005, 8th Edition

• Smeltzer, Bare, Hinkle, Cheever, Textbook of Medical Surgical Nursing, 2008, 11th Edition• Black, Hawks, Medical Surgical Nursing, Clinical Management for Positive Outcomes, 8th Edition